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Transcript
NUR 312: Pharmacology in Nursing II Unit II: Drugs That Affect Physical Regulation Psychoactive Drugs Purposes and Advantages of Psychoactive Agents Neurohormones: Dopamine . Serotonin Norepinepherine Categories of Psychoactive Drugs: 1. Antipsychotic Drugs: Uses Psychotic symptoms: positive symptoms of schizophrenia Delusions Hallucinations Illusions Phenothiazines: (1st. Generation) Thorazine (Chlorpromazine) Mellaril (Thioridazine) Prolixin Decanoate (Fluphenazine) Intramuscular (I.M.) Non Phenothiazines: (1st. Generation) Navane (Thiothixene) Haldol Decanoate (Haloperidol) Intramuscular (I.M.) Non Traditional Antipsychotics: (2nd. Generation) Less side effects Best to treat the negative symptoms of schizophrenia: Flat Affect, alogia (restricted thought and speech), Avolition/apathy Anhedonia/asociality, Attentional impairment Clozaril (Clozapine) (weekly or Bi weekly WBC) Risperdol (Risperidone) Zyprexia (Olanzapine) Abilify (Aripiprazole) Geodon (Ziprasidone) Side Effects of Antipsychotics: Sedation: drowsiness Weight Gain Risk for Diabetes Photosensitivity Dizziness Orthostatic Hypotension Sexual Dysfunction Elevation of Prolactin levels Anticholinergic Side Effects: blurred vision. dry mouth (cotton mouth), constipation, urinary retention Blood Dyscrasias: Agranulocytosis. low WBC Extrapyramidal SideEffects (E.P.S.) dystonia, akathesia, psuedoparkinsonism, cogwheel rigidity, masked facies, . oculogyric crisis, difficulty swallowing, stiffness of muscles, shuffling gait Nursinq Intervention: For EPS: Notify M.D. and obtain order for: (one of the drugs below) Cogentin or Artane (Anticholinergics) Symmetrel (Dopamine Agonist) Benedryl (Antihistamine) Tardive Dyskensia (irreversible) wormlike tongue movements, ataxia, Neuroleptic Malignant Syndrome (rare} 14-30% mortality Use Cautiously: diabetes, children under 6 Yr. , glaucoma, ulcers Interactions: CNS Depressants Nursing Implications: Antianxiety Drugs: Benzodiazapines & Miscellaneous, Action: Increase action of GABA that inhibits nerve transmission in the CNS Depresses activity in brainstem Sedative, hypnotic, anticonvulsant Therapeutic Uses: Commonly Prescribed Antianxiety Drugs: Valium (Diazepam) anticonvulsant in IV dose Xanax Versed Tranxene (Clorazapate), Librium, Ativan: used frequently for Detoxification from Alcohol Interactions: CNS Depressants or alcohol + Benzodlazepines = additive effect and Increased depression Tagamet, antabuse (disulfiram), MAOI, tobacco + Benzodizapines = decreased metabolism and increased depression Common Side effects: Overdose Flumazenil (Romazicon) Benzo. Receptor blocker (Antagonist) reverse effects Teaching: Buspar (Buspirone) Potent antianxiety drug but no muscle relaxant, anticonvulsant, sedative, or alcohol potentiating action Takes several weeks for antianxiety effects Use: Not effective with Panic Disorder or alcohol withdrawal Side effects: Inderal (Propranolol) Beta Blocker used for decreasing symptoms that lead to anxiety like tachycardia Antidepressants: Uses: Major Depression Anxiety Disorders Target symptoms: Amine Hypothesis Permissive Hypothesis Dysregulation Hypothesis Tricyclic Antidepressants: Elavil Tofranil Uses: ***2-4 weeks to have antidepressant effect Trazadone 2nd Generation Antidepressants: SSRI's (Selective Serotonin /Reuptake Inhibitors) Prozac Zoloft Paxil Other Newer Antidepressants Lexapro Wellbutrin /Zyban Effexor Vestra Remeron Side effects of Antidepressant Therapy and Interventions Overdose can be fatal due to "cardiac arrythemias with Tricyclics" Anticholinergic side effects: Dry mouth, Constipation, Urinary retention, nausea, diarrhea Psychomotor activationIinsomnia: take drug in morning, eliminate caffeine " Sedation, Drowsiness especially 1st week Ejaculatory Disturbances & decreased Libido, priapism Tremors, headache, nervousness Monoamine Oxidase Inhibitors (MAOI’s): Used for non responders to other antidepressant therapy Monoamine Oxidase: Role of tyramine and dietary restrictions: Life Threatening Side Effects of MAIO used with other drugs or foods: Hypertensive crisis: sudden elevation of BP, palpitations, chest pain, sweating, fever n&v Hold MAOI's, do not lie down (increases BP in head) Thorazine 100 mg. 1M repeat if necessary (blocks norepinepherine) Phentolamine IV in 5 mg dose (binds with. norepinepherine) Cooling blanket. Seratonin Syndrome: Occurs when SSRI’s are administered too close to D/C of MAOl's Confusion, disorientation, mania, restlessness, diaphoresis, shivering. Diarrhea, nausea. DIC all serotonergic drugs, anticonvulsants, Klonapin or Ativan **Do not reintroduce serotonin drugs Only 3 drugs Nardil Pamate Marplan Side Effects: Extreme hypotension Nursing Interventions: Careful health teaching on diet and drug reactions Dietary restrictions: Drugs that may produce hypertensive crisis: Mood Stabilizing Drugs: Lithium Carbonate usual dose is 900 mg/day Side effects & Nursing Implications: serum lithium levels .5 - 1.5 meq./L Lithium (continued) dose adjusted by serum level, not symptoms weight gain, fine hand tremors, mental dullness, polyuria, kidney impairment narrow therapeutic index:; toxicity a risk Symptoms of Lithium toxicity: Nursing responsibilities Anticonvulsant Mood Stabilizers Tegretal (Carbamazapine) Depakote (Valproic Acid) Neurontin Tegretal and valproic acid (depakote) serum levels Used in pt. who cannot tolerate Lithium and for bipolar disorder, schizoaffective disorder, borderline personality disorder, schizophrenia. Often used in combination with other medications Response in 1-2 weeks " Nursing Implications LMC/Aug. 2004